STRATEGIC COMMUNITY-BASED PARTNERSHIPS

Katherine Shealy, MPH, IBCLC, RLC Public Health Advisor Institute of Medicine Food and Nutrition Board April 26, 2011 Updating the USDA National Breastfeeding Campaign: Loving Support Makes Breastfeeding Work STRATEGIC COMMUNITY-BASED PARTNERSHIPS National Center for Chronic Disease Prevention and Health Promotion Division of Nutrition, Physical Activity, and Obesity

What community partners provide opportunities for FNS collaboration and what role can they play in Loving Support?

Necessary considerations: q Primary Loving Support goals What community partners provide opportunities for FNS collaboration and what role can they play in Loving Support? q Primary Loving Support audience q Primary role of FNS in community partnerships

Necessary considerations: What community partners provide opportunities for FNS collaboration and what role can they play in Loving Support? q Primary Loving Support goals Change mothers infant feeding decisions Remove barriers that impair mothers ability to carry out infant feeding decisions q Primary Loving Support audience Mothers and immediate circle of personal influencers Settings/people/groups that directly influence a mother s infant feeding decisions q Primary role of FNS in community partnerships Responsive supporter Pro-active initiator Engaged contributor (financial and human resources)

Sources of Information: Strategic Partners

Most mothers in the US want to breastfeed, everyone plays a part in making it easier for them to do so. Actions for: q Mothers and their families q Communities q Health Care q Employment q Research and Surveillance q Infrastructure

Who is everyone? Women Family members and friends

Sources of Information: Strategic Partners NWA National Breastfeeding Strategic Plan NWA Six Steps to Achieve Breastfeeding Goals for WIC Clinics Surgeon General s Call to Action to Support Breastfeeding White House Task Force on Childhood Obesity Report to the President Previous Loving Support activities Related Federal activities Business Case for Breastfeeding Let s Move CDC-funded state programs Communities Putting Prevention to Work (CPPW) US Breastfeeding Committee q National breastfeeding activities recognize strategic partnerships as essential to improving support Across Socio-Ecologic model Across agencies and programs Across program eligibility groups q National activities consistently identify partnerships among particular groups as paramount Local delivering hospitals and HCPs State BF coalitions, HC/HCP orgs, health dept Federal key Fed Agencies with related work

Clinicians Hospitals Doctor s offices Health care systems Third party payers HCP organizations Credentialing boards Joint Commission American Hospital Association

Local WIC clinics State WIC agencies Public health entities State and local health departments Federal health agencies

Who influences WIC moms decisions? Employers Employer organizations Chambers of Commerce Manufacturers Local government State government Federal government

Universities and Med Schools Institute of Medicine Local and state partners National partners and foundations

Current Partnerships Federal and National q q q q Federal Breastfeeding Workgroup 10 Federal agencies/offices Federal employees for whom breastfeeding is already a substantive part of their work. (grew out of experience of Federal steering committee for Call to Action) US Breastfeeding Committee 37 non-profit organizations, 7 Federal agencies/offices, and 2 individual members Independent non-profit org formed 1998 in response to WHO recommendation to establish multisectoral national breastfeeding committee comprised of representatives from relevant government departments, non-governmental organizations, and health professional associations to coordinate national breastfeeding initiatives. Breastfeeding Promotion Consortium 23 non-profit organizations, 13 Federal agencies/offices Established 1990 and co-hosted by FNS and HHS Text4Baby 138+ outreach partner organizations Unprecedented partnership launched Feb 2010 to get free health information to pregnant women and new mothers in vulnerable populations Currently nearly 500,000 subscribers

Example Partnership Opportunity Text 4 Baby

Current Partnerships State and Local Examples q University Medical Center, Jackson, MS WIC clinic in the hospital, fully collaborates with Postpartum unit, moms certified prior to discharge, assigned Peer Counselor q Georgia Local WIC clinic staff work with leadership at carpet factories in north Georgia employing large numbers of WIC moms to establish workplace support programs q New York State WIC and CDC-funded Obesity Program WIC participates integrally in program planning and activities Strategic partnership ensures consistent messaging across programs and shared utilization of resources q North Dakota WIC provides local support for coalitions, state Business Case for Breastfeeding initiative, and partners closely with CPPW team

Potential partnership activities q NWA and WIC agencies promote breastfeeding to other health care organizations and institutions (Goal 1, Objective 2) q NWA and WIC agencies promote breastfeeding within their communities (Goal 1, Objective 3) q WIC agencies educate public health organizations, educational institutions, and community organizations about WIC s role in breastfeeding promotion and support (Goal 3, Objective 1) q WIC management plays a leadership role in local, state, and national breastfeeding promotion and support efforts (Goal 3, Objective 2)

Ensure that maternity care practices throughout the US are fully supportive of Breastfeeding. Accelerate implementation of the Baby-Friendly Hospital Initiative. Establish partnerships for integrated and continuous follow- up care after discharge from the hospital. Establish and implement policies and programs to ensure that participants in WIC have services in place before discharge from the hospital. Ensure access to services Ensure access to services provided by International Board Certified Lactation Consultants. WIC agencies and NWA will work with the AHA and other stakeholders to increase the number of Baby-Friendly hospitals in the United States. WIC agencies will increase the visibility of and promote the BF Peer Counseling Program within their communities. State WIC agencies will partner with the AAP Chapter BF Coordinators and ACOG at the state level to promote consistent bf messages. State agencies will collaborate with programs that provide prenatal postpartum, and infant health care at the local agency level to ensure comprehensive bf promotion and support services.

WIC leadership will empower WIC personnel to actively engage in bf promotion programs and projects at the local, state, and national levels. WIC agencies will support and become active members of state, regional, and local breastfeeding coalitions. WIC agencies will encourage local agency staff to visit medical staff offices, schools, universities, and community organizations to share information about WIC s bf services and specific bf programs.

Strategic c Partnerships: Critically Necessary in All BF Efforts q Inconsistent information/support undermines the effectiveness and credibility of everyone Responsible parties for care in the critical windows have long-standing turf issues Stakes are high in each of the critical windows for support Vulnerability of mother/baby is tied to critical windows Negative impact of inconsistent support cascades forward

How can current and potential partners support FNS efforts in a new Loving Support campaign? q Amplify FNS messages Partnerships provide opportunities to reinforce messages mothers get during existing WIC interactions q Share the load Disconnected efforts make it harder for WIC staff to be effective, creating unnecessary extra burden and professional awkwardness if WIC is forced to correct what a participant learned elsewhere q Lend credibility WIC s efforts to rebrand to the public will only be successful if trusted, non-wic people and organizations echo WIC s messages prioritizing breastfeeding support

Major potential challenges need to be better recognized and addressed pro-actively. Potential Challenges: q Ownership q Credit/Blame q Territorialism q Permission q Perception of contributed value Strategies: q Identify roles q Ensure partnership is win-win q Celebrate successes q Learn from prior experience

Who is missing from the table and/or is essential in a new Loving Support campaign? q Department of Labor Federal and State Eager to partner New legislation requires employers to provide space and time, WIC moms are legitimately afraid to request accommodations q Breastfeeding Coalitions Local and State Coalitions are the nexus for partnership activities at local and state levels WIC role in coalitions needs to evolve Be better identified Be more pro-active Take fuller advantage of opportunities to engage in the community beyond current activities

Who is missing from the table and/or is essential in a new Loving Support campaign? q Hospitals individual hospitals and state/nat l orgs WIC staff consistently cite disconnect with hospitals as major barrier to being able to carry out their work Step 10 of the Baby-Friendly Hospital Initiative is to connect patients to post-discharge support in the community Wide range of partnership activity opportunities q Health Care Professional Organizations AAP, ACOG, etc. Mutual benefit to WIC and to HCPs to establish stronger ties and partnership activities For moms, lack of support from HCPs is a major barrier to bf

Thank you for convening this workshop. For more information: Katherine Shealy, MPH IBCLC, RLC 4770 Buford Highway NE, Mailstop K-25, Atlanta, GA 303 Telephone: (770) 488-5449 E-mail: kshealy@cdc.gov Web: http://www.cdc.gov/breastfeeding The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion Division of Nutrition, Physical Activity, and Obesity